Sachs Applies Clinical Thinking to Suffering Worldwide

Economist Jeffrey Sachs opened his keynote speech, “Clinical Skills, Global Solutions,” at the June 8 HMS/HSDM degree ceremony with a concession: since he is a PhD and not an MD, he may not be the most likely person to address new Harvard doctors on the application of clinical skills. Now the director of the Earth Institute at Columbia University and special adviser to UN Secretary-General Kofi Annan, Sachs said his approach to world problems was transformed by a visit to the poorest of the continents.

Photo by Steve Gilbert

In his address at the HMS/HSDM graduation ceremony, economist Jeffrey Sachs (left) said he had never truly appreciated the devastation of disease and poverty until he visited Africa. He urged a focused clinical and economic approach to alleviate this burden. Above with Sachs are HSDM dean Bruce Donoff (center) and HMS dean Joseph Martin.

“My life really changed fundamentally 12 years ago when I began my work in Africa,” he said. “…Until I got to Africa, I had not seen the nature of suffering on this planet straight, with clear eyes.” He recalled that when he arrived in Zambia, the first thing he was told was that seven of his 30 counterparts in the ministry of finance had died of AIDS during the preceding year.

This sort of devastation was commonplace. “It wasn’t only AIDS,” said Sachs, “but it was the pervasiveness of malaria, diarrheal disease, other parasitic diseases that engulf societies.”

Two main questions emerged from his experience: “What is the relationship of the extreme poverty that was so evident and the massive disease burden? …And second, what could be done about it and what were we doing about it?”

One answer, to his chagrin, was that we were not doing much, even though in the case of malaria, for example, up to three million people a year die from infection—about 90 percent of them in sub-Saharan Africa. Furthermore, the cycle of disease and poverty is virtually impossible for the afflicted population to break.

“I learned something … that I would never have dreamt,” said Sachs. “Despite all of the handwringing and the speeches and the pronouncements and the articles, as late as the end of the 1990s, we were doing essentially nothing from the rich world to help the poor.”

“As late as 1999, for example, the entire Western assistance budget to fight AIDS in Africa at a time when there were already 25 million HIV-infected individuals was $80 million a year.”

In 2000, Sachs was asked by the then head of the World Health Organization, Gro Harlem Brundtland, to try to bring together the financial world and the public health world to find a solution. The resulting commission he headed determined that disease burden is crippling much of the poor world, particularly sub-Saharan Africa. And the diseases that account for most of the excess burden are AIDS, malaria, tuberculosis, diarrheal diseases, acute lower respiratory infection, nutrient deficiencies, vaccine-preventable diseases, eukaryotic parasites, and unsafe childbirth.

“What you know very well,” Sachs said, addressing the new graduates, “is that every one of them has protocols for prevention and treatment, powerful technologies, known methods of attack. And the costs of those … was well under two tenths of one percent of the rich world’s income to enable those interventions to reach all of the poorest of the poor.”

Sachs said that more recent efforts like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which is an international partnership, is “proof of what clinical medicine can accomplish. But I can tell you, till today, the ground reality is that we know what to do—it’s utterly affordable—but to this moment, we still have chosen and … we are still choosing to let 10 million people die every year because they are too poor to stay alive.”

Sachs, who wrote The End of Poverty: Economic Possibilities for Our Time, explained a term he coined, “clinical economics,” as a practical method of focusing resources on a particular problem. “It’s to take science and deep understanding and apply them critically to a specific instance. It’s that translation and application to a specific circumstance, which is vital.”

“If we apply this clinical reasoning not only to the medical challenges, the public health challenges, but to the challenges of growing more food or finding how the local hydrology can deliver safe drinking water or how the internet can be used to end isolation of … villages cut off from the rest of the world or the other most practical challenges that the poorest of the poor face,” he said, “if we use those clinical skills with the rigor, the commitment, the ethics, and the decency with which you will use them, we have in our hands the capacity to transform the world.”

—Robert Neal

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